XP: Another question about MaterniT21

bobbydsgirl · April 2013

Hello, ladies -

I am a new poster on this board. I am 35 and have suffered 3 previous losses, but happy to report that I had a u/s yesterday at 9w4d and things are looking good! Measuring 9w5d with a heart rate of 178. The fetus wasn't moving that I could tell, but my OB said this was normal at this stage (I hope!).

I am posting with a question about your experience with MaterniT21 testing. Mainly, did you get an answer about how much it would cost before the appointment, and were you required to have an u/s on the day of the blood draw?

I'd like to just get a simple blood draw and know in advance how much it will cost if insurance doesn't cover it, but the specialist's office is being difficult. They don't want to tell me the cost until the day I come in for the test, and they also want to require an u/s before the test which I think is unnecessary since I just had one this week and I am wary of doing them too often.

Thanks for your input!

10-4LilBuddy · April 2013

I had my Mat21 test done this Monday at 10w 6d. I think that's the earliest they can do it. (It really should be 11 weeks, but I went in because I had some cramping that turned out to me a muscle strain.)

I had my NT ultrasound done right before the blood draw. The NT u/s is a visual scan of the baby (in my case, babies). They measure key markers - head size, overall size, limbs, fluid along spinal cord, brain development, etc. These markers serve as reference as your baby grows. It is also a visual check for any physical anomolies. My office does it at the same time as the Mat21 test because they want to have the same baseline. I think you can do the test and ultrasound up to 16 weeks if you want to space it out from your recent ultrasound.

Regarding price, Mat21 is a relatively new test and isn't covered by a lot of insurance plans. However, the company that makes and administers the test wants to make it more popular to make it generally accepted. Due to this, the company will try to bill your insurance first. If the insurance doesn't cover it, then the company will charge you a flat $235. If you want them to check the gender, you must request it. Otherwise, they just check for trisomies.

Hope this helps. This is what my doctor's office does and has told me so yours may have different reasoning.

Maimes10 · April 2013

So sorry to hear about your tough journey, but i'm feeling a kinship because you and have very similar stories. 2 miscarriages and this pregnancy started out as a twin pregnancy and we lost one. I am excactly 10w0d today and went in today for my blood draw for MaterniT21 test.

I was told by my genetics counselor that the test was $2700 out of pocket if insurance didn't cover. The lab that my hospital uses, you can actually call them ahead of time and give them your insurance info and they will tell you if you are covered or not and what your out of pocket will be.

BEST of luck to you. This is a nerve wracking time, my husband and i are just barely starting to breathe...such a roller coaster but as long as this one works out it will all be worth it!

bobbydsgirl · April 2013

10-4LilBuddy:
I had my Mat21 test done this Monday at 10w 6d. I think that's the earliest they can do it. (It really should be 11 weeks, but I went in because I had some cramping that turned out to me a muscle strain.)

I had my NT ultrasound done right before the blood draw. The NT u/s is a visual scan of the baby (in my case, babies). They measure key markers - head size, overall size, limbs, fluid along spinal cord, brain development, etc. These markers serve as reference as your baby grows. It is also a visual check for any physical anomolies. My office does it at the same time as the Mat21 test because they want to have the same baseline. I think you can do the test and ultrasound up to 16 weeks if you want to space it out from your recent ultrasound.

Regarding price, Mat21 is a relatively new test and isn't covered by a lot of insurance plans. However, the company that makes and administers the test wants to make it more popular to make it generally accepted. Due to this, the company will try to bill your insurance first. If the insurance doesn't cover it, then the company will charge you a flat $235. If you want them to check the gender, you must request it. Otherwise, they just check for trisomies.

Hope this helps. This is what my doctor's office does and has told me so yours may have different reasoning.

Thanks for this info. It's helpful!

bobbydsgirl · April 2013

Maimes10:
So sorry to hear about your tough journey, but i'm feeling a kinship because you and have very similar stories. 2 miscarriages and this pregnancy started out as a twin pregnancy and we lost one. I am excactly 10w0d today and went in today for my blood draw for MaterniT21 test.

I was told by my genetics counselor that the test was $2700 out of pocket if insurance didn't cover. The lab that my hospital uses, you can actually call them ahead of time and give them your insurance info and they will tell you if you are covered or not and what your out of pocket will be.

BEST of luck to you. This is a nerve wracking time, my husband and i are just barely starting to breathe...such a roller coaster but as long as this one works out it will all be worth it!

Thank you for your kind words. DH and I are trying to relax, too, now that we are almost at 10w. But it's a constant battle, especially for me. I hope I will feel better once I get the T21 results back and can consistently find the hb with the doppler. I wish you a healthy and happy remaining 7 months - and the best results from the T21 - please post an update!

Abeille · April 2013

You can call Sequenom and get the billing codes for the test. Provide those codes to your insurance provider and they should be able to tell you right away what kind of coverage you'll have.

That's what I did for the Harmony test (same test, different lab). It was only a blood draw, no u/s. HTH.

stephzrn · April 2013

I had this test at 10 weeks. No ultrasound was done prior to the draw. If you doctor bills it as advanced maternal age, then insurance will pay for it. They won't pay for it if you are less then 36 years old. I am 40 and we didn't have to pay a single penny. In regards to what the previous poster said about sex. You don't have to request it. They are looking the the babies DNA so they know if there is an X or Y chromosome. The doctor's office just asked if we wanted to know the sex when they called us our results. Good luck to you

10-4LilBuddy · April 2013

Maimes I would check with the Mat21 company before paying out of pocket. I was told by a few different people that the company will write down the bill to a flat 235 or something like that.

beccabrad · April 2013

Actually the cost of MaterniT21 just changed last week. It's now $200 max that you will pay. Regardless if your insurance covers 80% or 0%.

geminikah · April 2013

I had mine and was quoted 235.00 if insurance does not cover. I am aware that they did raise the out of pocket to 500 if not covered by insurance but because I was quoted 235.00 they honor it. The 2000 something quote is what they bill insurance. You will be able to tell the gender because they screen for x and y specific genetic diseases. If you are absent any Y then they know it is a girl. You can tell them not tell you at your doc office. I had them put in sealed envelope for a gender reveal party. There is only one lab that does this test out of San Diego CA...just an fyi!

Rubygirl · April 2013

I've seen some conflicting info, so here's more to add to the list. Sorry! From my understanding the latest you can do the NT scan (u/s) is 13w6d. MaT21 can be done anytime after 10 weeks.

I got the NT scan but wish I'd just skipped it (and the cost).

MaT21 - my advice is to let Sequenom do the insurance research for you. Call their number (from their website), talk to billing. They will call your insurance and call you back with the cost. They can also provide info on what the cost would be not filing w/ insurance. They no longer offer the $235 flat rate. It is now income based, so they will ask a lot of questions about your household income and how many kids/dependents you have. Cost could be $0 or $600, it just depends.

Good luck!

bobbydsgirl · April 2013

Thanks for the input. It is strange how Sequenom is telling different women different things. I wonder if it depends on your state. I called today and they told me a Max of $200. They didn't ask about income.

beccabrad · April 2013

bobbydsgirl:
Thanks for the input. It is strange how Sequenom is telling different women different things. I wonder if it depends on your state. I called today and they told me a Max of $200. They didn't ask about income.

This is what I said above. It just changed last week (Thurs to be exact).

Roses in May · April 2013

I had this test several weeks ago after the Harmony test came back twice as unable to obtain results. The company that performs the test called just a few days after the sample had been taken & in a round about way asked me how much I had been told the test would cost. I said I thought it was a max of $235 or so. She sighed & said they would honor that price but that I might be billed for more & if so I needed to call them to have them reduce it. From other posts I've seen it sounds like the price is going up to the $700 neighborhood. I have yet to receive a bill or a denial from my insurance. The good news is I was able to get results, the baby is clear of the tested issues & is a boy.

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XP: Another question about MaterniT21

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